Impact of a clinical pathway tool on appropriate palliative radiation therapy for bone metastases

Publication date: Available online 8 December 2017
Source:Practical Radiation Oncology
Author(s): Lisa S. Rotenstein, Alexander O. Kerman, Joseph Killoran, Tracy A. Balboni, Monica S. Krishnan, Allison Taylor, Neil E. Martin
PurposeClinical pathways increase compliance with treatment guidelines, improve outcomes, and reduce costs. Guidelines recommend single fraction radiation therapy (SFRT) for palliation of uncomplicated bone metastases, but implementation is variable. We examined the effects of a pathway tool on SFRT rates in an academic radiation oncology practice.Materials and MethodsUsing published literature, clinical guidelines, and expert input, we designed a clinical pathway for bone metastases radiotherapy displayed on a web-based electronic interface. In March 2016, the pathway launched on a palliative radiation service at the XXX Cancer Center main campus and at affiliated community sites. Providers were surveyed pre/post-implementation to assess expectations and elicit feedback. Rates of pathway utilization, compliance with SFRT recommendations, and reasons for non-compliance were assessed.ResultsThe final pathway includes twenty endpoints and several validated prognostic scoring systems. It was used in 38% of 723 bone metastases radiation prescriptions, with appropriate SFRT rates rising from 18% prior to implementation to 48% post-launch (p<0.01). Major reasons for rejecting recommendations included disagreement with life expectancy prognostication and patient convenience. The pathway increased physicians' confidence regarding compliance with treatment guidelines and made it easier to find well supported treatment recommendations. Workflow disruptions and the inability to handle nuanced situations emerged as limitations.ConclusionsOur experience demonstrates the utility of clinical pathway decision support for bone metastases radiation in complex academic settings. Next steps include increasing the pathway's ease of use, refining the pathway's prognostic abilities, and measuring cost savings related to the pathway.



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